Donation Form
Donor Information
First Name:
Last Name:
Street:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
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Zip:
Telephone:
(Home)
Telephone:
(Business)
Fax:
E-mail:
Donation Level
$50,000
Cabinet Member
$10,000
Senator
$5,000
Ambassador
$1,000
Representative
$
Other ($10,000 PayPal Maximum)
Payment Options
Cash / Check / Money Order
Stock Transfer
Credit Card / PayPal
Acknowledgement Information
Please use the following names in all Acknowledgements:
I (we) wish to have this gift remain anonymous
176 North Mill Street | Lexington, Kentucky 40507 | 859.231.0315 • 859.231.0415
